Introduction to Emergency Medical Care 1 · 2015-08-23 · Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson OBJECTIVES 1.5 Compare and contrast the training and

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Emergency Care, Twelfth Edition

Limmer • O’Keefe • Dickinson

Introduction to Emergency

Medical Care

1





OBJECTIVES

1.1 Define key terms introduced in this chapter. Slides

16-18, 26–27, 42–44

1.2 Give an overview of the historical events leading to

the development of modern emergency medical

services (EMS). Slides 10–13, 19

1.3 Describe the importance of each of the National

Highway Traffic Safety Administration standards for

assessing EMS systems. Slides 14–18

1.4 Describe the components of an EMS system that

must be in place for a patient to receive emergency

medical care. Slides 21–27

continued





OBJECTIVES

1.5 Compare and contrast the training and

responsibilities of EMRs, EMTs, AEMTs, and

Paramedics. Slides 28–33

1.6 Explain each of the specific areas of responsibility for

the EMT. Slides 28–29, 31–33

1.7 Give examples of the physical and personality traits

that are desirable for EMTs. Slides 34–39

1.8 Describe various job settings that may be available to

EMTs. Slide 40

1.9 Describe the purpose of the National Registry of

Emergency Medical Technicians. Slide 41

continued





OBJECTIVES

1.10 Explain the purpose of quality improvement

programs in EMS programs. Slides 42–43

1.11 Explain EMTs’ role in the quality improvement

process. Slides 42–43

1.12 Explain medical direction as it relates to EMS

systems. Slide 44

1.13 List ways in which research may influence EMT

practice. Slide 45

continued





OBJECTIVES

1.14 Give examples of how EMS providers can play a

role in public health. Slide 46

1.15 Given scenarios, decide how an EMT may

demonstrate professional behavior. Slides 29, 32–

33, 47





MULTIMEDIA

• Slide 19 The Long and Winding Road of Ambulance

Service Video

• Slide 48 Emergency Medical Services for Children

Video





• The chain of human resources that forms

the EMS system

• How the public activates the EMS system

• Your roles and responsibilities as an EMT

• The process of EMS quality improvement

(QI)

CORE CONCEPTS





Topics

• The Emergency Medical Services System

• Components of the EMS System





The Emergency Medical

Services System





How It Began

• 1790s—Napoleonic Wars

• Civil War

• World War I—Volunteer ambulance corps

• Korea/Vietnam—MASH-type units and

helicopter transport from battlefield

continued





(Bettmann/CORBIS.)





How It Began

• Non-military ambulance services began

operating in early 1900s in U.S.

• Often operated by hospitals, fire

departments, or funeral homes

• No requirements or standards for

equipment, crew training, or ambulance

design

• “You call, we haul, that’s all!”





Development of Today’s EMS

• 1966—Department of Transportation

charged with developing EMS standards

• 1970—Founding of National Registry of

EMTs (NREMT)

• 1973—National Emergency Medical

Service Systems Act (NEMSSA)





NHTSA Standards

for EMS Systems

1. Regulation and Policy

– Each state establishes laws, policies, and

regulations

2. Resource Management

– Centralized coordination of emergency

treatment and transport resources

continued





NHTSA Standards

for EMS Systems

3. Human Resources and Training

– Assure EMS personnel are trained and

certified to minimum standard by qualified

instructors

4. Transportation

– Provide safe, reliable transportation—ground,

air, or other means

continued





NHTSA Standards

for EMS Systems

5. Facilities

– Must be transported to closest appropriate

facility

6. Communications

– Universal access number (911), dispatch to

ambulance, ambulance to ambulance,

ambulance to hospital, hospital to hospital

continued





NHTSA Standards

for EMS Systems

7. Trauma Systems

– Develop trauma triage, transport, and

treatment protocols

8. Evaluation

– Establish program for assessing and

improving quality of care provided (QI, QA,

TQM)

continued





NHTSA Standards

for EMS Systems

9. Public Information and Education

– Educate public about role of EMS, increase

public awareness, participate in injury

prevention programs

10.Medical Direction

– Medical director oversees, is accountable for

EMS personnel within system





Click here to view a video on the topic of the history of EMS.

Back to Directory

The Long and Winding

Road of Ambulance Service Video

media/LongWinding.htm





Components

of the EMS System





Components

of the EMS System

• Emergency Department/Hospital

– Doctors, nurses, allied health personnel

continued





Components

of the EMS System

• Other specialized

care facilities

– Trauma centers

– Burn centers

– Stroke centers

– Cardiac centers

– Labor and delivery/

pediatrics

– Poison control





Think About It

• What medical services are available in

your community?

• How important is it that EMS personnel

know the capabilities of community

medical facilities?

• What are the possible consequences of

transporting a patient to a facility not

equipped to handle the problem?





Chain of Human

Resources in EMS System





Accessing EMS System

• 911 telephone access

– Available in most but not all areas

• Enhanced 911

– Provides caller number and location for

landline phones

• Cell phones

– Newer models may provide location in some

areas





Emergency

Medical Dispatchers • Can provide instructions to callers on how

to provide emergency care until EMS

personnel arrive

• EMD certification required in some

jurisdictions









Critical Decision Making

• Critical decision making is very important

in EMS

• Information must be gathered, patients

assessed, and determination made on

treatment and transport options

• Decisions often time-critical





Examples of Critical Decisions

• Is it better to take patient to closest

hospital or to one farther away but more

appropriate for the condition?

• Is patient stable enough for further

evaluation on scene, or should patient be

transported immediately?

• Will this treatment make patient better or

worse?





Levels of EMS Training

• Emergency Medical Responder (formerly

First Responder)

• Emergency Medical Technician (formerly

EMT Basic)

• Advanced EMT (formerly EMT

Intermediate)

• Paramedic (formerly EMT Paramedic)





Roles and

Responsibilities of EMTs • Personal safety

• Safety of crew, patient, and bystanders

• Patient assessment

• Patient care

• Lifting and moving

• Transport

• Transfer of care

• Patient advocacy





Think About It

• How would it impact elderly patient if

transported to the hospital without glasses,

hearing aid, or dentures?

• On a routine call, would taking the time to

gather these items have a negative effect

on the patient’s care?

• How about assuring the home is secure

and locked before leaving?

continued





Think About It

• Could the concept of patient advocacy

also extend to the community (fall

prevention programs for elderly, poisoning

awareness, pool and water safety

programs for children)?





Physical Traits

of a Good EMT • Ability to lift and carry equipment and

patients

• Good eyesight (distance and reading) and

color vision

• Good communication skills (oral and

written)





Personal Traits

of a Good EMT • Pleasant

• Sincere

• Cooperative

• Resourceful

continued





Personal Traits

of a Good EMT • Self starter

• Emotionally stable

• Able to lead

• Neat and clean

continued





Personal Traits

of a Good EMT • Good moral character

• Respectful of others

• Control of personal habits

• Control of conversation

• Able to communicate

properly

• Able to listen to others

• Nonjudgmental and fair





Education

• Maintain up-to-date knowledge and skills

• Read EMS magazines; join EMS

organizations

• Refresher courses for recertification

• Continuing education to supplement

original training

continued





Education

• Conferences, seminars, lectures, classes,

videos, and demonstrations





Job Opportunities

• Ambulance

services

• Fire departments

• Medical facilities

• Rural/wilderness

teams

• Industrial settings





National Registry

of EMTs (NREMT) • Registration for EMRs, EMTs, AEMTs, and

paramedics who successfully complete

NREMT examinations

• May help in reciprocity (transferring to

another state or region)

• Considered favorably when applying for

employment





Quality Improvement

• Continuous self-review to identify areas for

improvement

• Develop plans to address areas

continued





Quality Improvement

• Everyone in organization has a role

– Prepare careful documentation

– Involved in quality process

– Get feedback from patients, hospital staff

– Maintain equipment

– Continuing education





Medical Direction

• Medical Director: ultimate responsibility for

patient care aspects of EMS system

• All patient care performed under direction

of Medical Director

• Oversees training; develops treatment

protocols

• Off-line medical control (standing orders)

• On-line medical control





Research

• Vitally important; more needed in EMS

field

• Care should be based on evidence-based

research rather than tradition

• Goal is improving patient outcomes

• Form a hypothesis, review literature,

evaluate evidence, and adopt practice if

evidence supports it





EMS Role in Public Health

• Injury prevention for

geriatric patients and

youth

• Blood pressure clinics

• File of life

• Public vaccination

programs

• Disease surveillance





Think About It

• How will you refresh your knowledge and

stay current once you are out of the

classroom?

• What qualities would you like to see in an

EMT who is caring for you? How can you

come closer to being this kind of EMT?





Emergency Medical

Services for Children Video

Click here to view a video on the topic of emergency medical services

for children.

Back to Directory

media/CHN_EMSforchildren.htm





Chapter Review





Chapter Review

• EMS system includes 911 or other

emergency access system, dispatchers,

EMTs, hospital emergency department,

physicians, nurses, physician’s assistants,

and other health professionals.

• EMT’s responsibilities include safety;

patient assessment and care; lifting,

moving, and transporting patients; transfer

of care; and patient advocacy. continued





Chapter Review

• EMT must have certain personal traits to

ensure the ability to do the job.

• Education, quality improvement

procedures, and medical direction are all

essential to maintaining high standards of

EMS care.





Remember

• EMS dates back to Napoleonic times.

• Modern EMS standards come from

1960s–1970s and National Emergency

Medical Service Systems Act (NEMSSA).

• There is a chain of human resources

involved in EMS. Critical decisions are

made by each member of the chain.

continued





Remember

• There are certain personal and physical

traits that help you to be a successful EMS

provider.

• An EMS provider should actively pursue

opportunities to improve personal

knowledge and abilities as well as the

unit’s overall quality.





Questions to Consider

• What innovation was introduced in the

Korean and Vietnam wars that is now

common in many EMS systems?

• What are the four levels of EMS

providers?

• Requesting orders from a physician by

radio is an example of what kind of

medical control?





Critical Thinking

• Your patient is hesitant to go to the

hospital because she is worried about her

dog. What can you do to assist in this

situation? What part of your role as an

EMT is this an example of?





Please visit Resource Central on

www.bradybooks.com to view

additional resources for this text.

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Documents

Introduction to Emergency Medical Care 1 · 2015-08-23 · Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson OBJECTIVES 1.5 Compare and contrast the training and